Fundamentals of Pharmacology. Группа авторов
medication
Many medications come with cautionary or advisory information that should be added by pharmacists when dispensing the requested medication. Appendix 3 has a list of approved cautionary and advisory labels, each with a specific code number. The number associated with the label is found in the drug monograph in the medicinal forms section below the preparation chosen. It is important to advise the patient on the additional advice or directions given for taking their medication. A full list of the labels and wording is found both in Appendix 3 and in the back pages of the print BNF.
Skills in practice
Using the index, find olanzapine in the BNF.
Using the drug monograph, find the medicinal form section.
Identify the cautionary and advisory label number given for oral tablets.
Use Appendix 3 to identify what the label states.
What additional information is provided?
How would you discuss this with the patient?
Wound management products and elasticated garments
Appendix 4 offers details of products that are used for wound management and garments that require a prescription. Best practice and clinical recommendations should be consulted to ensure the most appropriate item is chosen. Often in acute or inpatient settings, the clinical environment has a stock of regularly used dressings or bandages or other medicinal devices, such as surgical adhesive tapes. These remain individual prescribed patient items and should be considered as such on discharge or transfer of care. It is essential that the supply of wound care products, and associated treatment information, should be prepared and documented as per any other medication or medical product or device. This information is paramount for community care providers, practice nurses and general practitioners in order to maintain high‐quality care standards.
Emergency care protocols, units, conversions and abbreviations
The BNF print version acts as a reference guide for practitioners in emergency situations. The adult advanced life‐support algorithm and an overview of community‐based medical emergency management provides a valuable resource in emergency situations.
Conversions and unit tables are presented as a reference followed by the cautionary and advisory label wordings discussed previously. The inside back page lastly provides a guide to the abbreviations and symbols used which are internationally recognised.
Online and mobile application BNF
In an increasingly paper‐free healthcare system, you may not have access to paper copies of the BNF. The BNF has an online platform accessed via the National Institute for Health and Care Excellence (NICE), or via Medicines Complete (https://about.medicinescomplete.com) as well as an offline app that can be used on smart phones and tablets. The BNF online https://bnf.nice.org.uk or BNF for children https://bnfc.nice.org.uk is updated monthly and as such is often more up‐to‐date than the print version and does not require a specific log‐in. The app is automatically updated monthly (when connected to wi‐fi).
When you visit the home page of the BNF online (via NICE), you are presented with clear options for navigation. All the same information is held online as in print – but navigation is different. Drugs (as drug monographs), interactions and treatment summaries can be searched for by browsing an alphabetised list or the search bar at the top of the webpage. The home page also has a ‘type’ organisation where quick access to areas such as wound management, borderline substances and nurse prescribers' formularies can be found.
Searching for atenolol (for example) and opening its page displays information under the atenolol drug monograph. A table of contents is provided for rapid navigation of the subsections available. On scrolling down the opening page, indications and dose are clearly presented alongside routes of administration. Next, licensing information, safety information and contraindications are displayed.
Figure 2.2 Contraindication and class monograph.
Cautionary and advisory labels are indicated when a medicinal form is selected both by label number and the associated text. In addition, the schedule of any controlled drug is clearly documented in its medicinal form information.
Associated class monograph information is integrated throughout the chosen drug monograph and indicated by the phrasing ‘for all ….’ An example of this can be seen in the contraindications for atenolol (Figure 2.2).
Searching for interactions is managed within a dedicated interactions section by an initial drug search and then matching to a subsequent alphabetical list. The associated interaction is discussed in terms of potential effects of the interaction, signposting to relevant additional sections of the BNF such as ‘Drugs and driving’ in ‘Guidance for prescribing’ and has associated hyperlinks for ease of use. Severity of interactions are defined using terms of severe, moderate, mild and unknown to support decision‐making alongside the type of evidence underpinning the interaction information.
Key to safe and accountable practice is the recognition and reporting of suspected adverse reactions or effects of medication. The BNF supports active reporting of adverse reactions by both healthcare professionals and patients themselves or their carers. Using the Yellow Card Scheme, the Medicines and Healthcare Products Regulatory Agency (MHRA) collects information on medications, vaccines, herbal treatments, medical devices, defective medications, and – from 2016 – counterfeit or fake healthcare products and e‐cigarettes. The print copy of the BNF and BNFc have a small supply of yellow cards in the back matter; alternatively concerns can be raised using the UK MHRA Yellow card webpage https://yellowcard.mhra.gov.uk. Chapter 7, Adverse Drug Reactions in this book provides more details of this.
MIMS (Monthly Index of Medical Specialities)
Within a primary care setting, you may also come across the MIMS prescribing guide. This is an up‐to‐date prescribing reference for healthcare professionals and it is available both in print and online. MIMS is updated constantly online, to reflect the latest approved prescribing information, along with the addition of new drugs and formulations, and also removes products that are no longer available. The printed version of MIMS is produced quarterly and includes all the updates from the corresponding three months of online updates. MIMS is primarily intended for use by GPs and nurses working within primary care. A subscription is required for nurses who wish to receive the print version. All other prescribing healthcare professionals – such as paramedics, dietitians and physiotherapists – need to subscribe to MIMS to access either the online or print versions. MIMS is a helpful prescribing resource and provides:
News on changes that affect medicines and prescribing.
Drug information for branded and generic products, updated daily.
At‐a‐glance drug comparison tables including dosing and monitoring regimens, available presentations, prices, potential sensitisers and compatible devices.
Quick‐reference summaries of key clinical guidance from authoritative national bodies, including NICE and the Scottish Intercollegiate Guidelines Network (SIGN).
Online